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Many people know that people who abuse alcohol often have memory problems. But not everyone understands that memory loss due to alcoholism is one of the signs of a serious illness, known in medicine as amnestic syndrome.
What is amnestic syndrome
Amnestic syndrome is a mental disorder caused by structural or chemical damage to brain cells, accompanied by memory impairment. This disease can manifest itself in different ways. As a rule, the patient loses real memories, and false ones appear in their place. In addition, people with this diagnosis have very poor spatial orientation and lose their sense of time.
Often, against the background of infectious diseases affecting the central nervous system, brain injuries, strokes, tumors, cerebrovascular diseases, Wernicke encephalopathy, and degenerative changes, the so-called organic amnestic syndrome (caused by organic processes occurring in brain cells) develops. In people suffering from alcoholism, amnesia is a consequence of a severe deficiency of B vitamins, which are essential for the proper functioning of the brain. This type of amnesia is medically known as Korsakov's syndrome (named after the Russian psychiatrist S. Korsakov, who described the disease). In addition, amnestic syndrome can develop due to drug addiction or under the influence of toxins such as mercury, lead, carbon monoxide.
Cognitive impairment in Korsakoff syndrome
With Korsakov's syndrome, not only memory suffers, but also thinking changes - it becomes stiff, monotonous, and intellectual failure is observed. Patients often do not notice contradictions in their speech. The level of volitional activity also drops. People often sit idle. An apathetic mood background often predominates. Although this is more common among older people, younger people are more active.
Clouding of consciousness is most often not observed with this syndrome. Actually, Korsakov's syndrome occurs after an acute period of the main syndrome. That is, during the period of enlightenment of consciousness. But sometimes it happens. Clouding of consciousness in such cases is combined with delirium (a mental disorder with true hallucinations, delusions, characterized by a persistent disturbance of orientation in time and space). During periods of exacerbation, patients become restless, especially at night.
Korsakoff syndrome may have signs of memory impairment of varying severity. Sometimes patients themselves notice that something wrong is happening with their memory. They try to recreate forgotten events through fictitious memories quite consciously in order to hide their problems.
The behavior of patients is often situational. For example, when entering a doctor’s office and seeing a book, they may begin to read it and begin to sort through the papers lying on the table. When they see a blank sheet of paper and a pencil or pen lying nearby, they will write on it.
If Korsakoff's syndrome arose due to severe damage to the fronto-basal parts of the brain, then, together with serious memory impairment, a euphoric (unreasonably elevated) mood or, as the opposite, an apathetic state is observed. With euphoria, patients are extremely uncritical, behave foolishly, and are often inappropriate to the surrounding environment. With apathy, patients are unable to finish what they have started, or make a conscious choice of activity or action; initiative in this regard is not available to them. They are able to act only according to clear instructions, but due to lack of motivation they cannot complete the task.
With CS, verbal memory suffers more. Disorientation in time and space is often observed. Patients cannot find their room in the hospital corridor, their bed. They don’t remember the names of their roommates. They cannot name the current day of the week, month, or season. People with CS are very suggestible. If confabulations are present in the clinic of this amnestic syndrome, then their content can be changed with the help of questions. For example, to the question “What did you do yesterday?”, you can get the answer “I was at work.” If you remind him that this is impossible, then the patient will quickly and easily change his mind and agree that he was in the hospital yesterday and will add more untrue details to this statement. I don't see any contradiction in this at all. And after 10 minutes, at most, he will completely forget about it. Often statements are fantastic and unrealistic.
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How does the disease manifest itself?
Amnestic syndrome caused by alcohol abuse can manifest itself in a variety of symptoms. As a rule, such people lose the ability to remember new information and adequately restore the chronology of what happened. They often confuse events, but this cannot be called a conscious lie on the part of the patients, since they firmly believe that everything happened exactly as they describe.
In many cases, amnesia is retrograde in nature: the memories that he had before the onset of the disease are erased from the patient’s memory. Other patients may have anterograde amnesia, where a person loses the ability to accumulate new memories. That is, such a patient, without much effort, is able to immediately repeat a short story and a certain set of numbers, but after several hours or even minutes (depending on the progression of the disease), he will not remember this. In addition, many patients experience confabulation, which manifests itself in complete disorientation and the desire to pass off fictitious events as reality. Another feature of the disease is that the character of patients almost completely changes, as if the main features of their personality are erased. People with amnestic syndrome, as a rule, behave without initiative, in most cases they show apathy and pronounced dependence on others.
In people who abuse alcohol, signs of amnesia may appear not only as a consequence of delirium (delirium tremens). As the disease progresses, the symptoms of amnestic syndrome become more and more noticeable, and memory disorders become chronic. Most patients with amnestic disorders completely deny the presence of the disease; others admit that they have memory problems, but still do not realize the extent and seriousness of the disease.
It is difficult to talk about the demographic characteristics of amnestic syndrome. It can manifest itself in men and women of different ages, depending on the causes of the disease. Especially when it comes to amnesia resulting from injury or a serious illness. According to statistics, alcohol amnestic syndrome most often occurs in people 40 years of age and older with a long history of alcohol abuse. Amnesia due to drug use is a problem among 20-40 year olds, and in people over 60, the disease is usually the result of age-related changes and certain diseases.
Manifestations of Korsakov's syndrome
Patients remember what happened to them before the onset of memory loss. They remember the events of past years, the history of their lives, and do not lose professional knowledge. They can tell you where they studied, lived, and worked before their illness. They remember the distant past relatively well. But at the same time, they cannot remember what they did literally three or five minutes ago. They say hello to the doctor and people around them many times. Often this syndrome is observed with damage to the hippocampus of the brain. A special form of CS is fixation amnesia with disturbances of consciousness.
With all their characteristics, patients can still imprint and reproduce the material presented to them, albeit to a very limited extent (out of 10 characters, after a single repetition, they can reproduce 4-5). But if there is a pause between presentation and reproduction, then they immediately have serious difficulties. If this pause is filled with something (a change of activity, for example, a conversation on abstract topics), then the situation with reproduction worsens even more.
Patients have no reserve for compensation of the defect. In other words, even if the patient is interested in the examination or the presented material is structured and distributed into logical groups (to facilitate memorization), this has no effect. Patients still show disappointing results.
Often, the clinical picture of the disease also contains confabulations - symptoms of impaired consciousness, in which patients fill memory gaps with non-existent events or real events, but transfer them to another time, most often, which is closer to the present, supplementing them with fictitious details. Confabulations themselves can exist both with and without memory failures, and can exist separately. The same combined manifestations are observed in a number of mental illnesses. Confabulation is usually absent in children with Korsakoff's syndrome, but is very common in older patients.
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In patients with the structure of the syndrome, retrograde amnesia is observed - loss of memory of events that happened shortly before the disease and anterograde amnesia - loss of memory for events after the onset of the disease.
Patient M., after carbon monoxide poisoning, remained in a comatose state for 8 days; after emerging from it, she talked about events that could not happen to her. I recognized the relatives who visited her. Each time I met the doctor it was like the first time, each time I greeted him. She was asked questions about the state of her memory, she answered that her memory was fine. She was in an unreasonably high mood and was sure that nothing bad was happening to her.
How to treat amnesia
Amnestic syndrome can manifest itself in acute or chronic form. If the disease is not treated, the patient can live from 2 to 15 years. The rate of disease progression is determined by various factors. If a patient has alcoholism, it is reasonable to say that the development of amnestic syndrome depends on the amount of alcohol consumed.
The effectiveness of treatment for alcohol amnestic syndrome essentially depends on a single factor: whether the patient can overcome the craving for alcohol. This is the first and most important step towards improving your condition. Quitting alcohol will significantly reduce the risk of developing Wernicke encephalopathy (this disease develops against the background of vitamin B1 deficiency and significantly worsens the patient’s condition).
To improve the patient’s condition in a hospital setting, he is given shock doses of thiamine (vitamin B1) in the form of injections or tablets, and a course of nootropic drugs and Cerebrolysin is prescribed. This program allows you to improve metabolic processes in the brain and thereby activate its work. In addition to drug treatment, patients must follow a special diet consisting of foods rich in vitamin B1. This is the only way there is a chance to stop the progression of the disease and restore lost memories. Although doctors say directly, amnesia caused by alcohol abuse is much more difficult to treat.
Treatment of amnestic syndrome usually takes quite a long time. But this is not the only drawback of therapy. Even in a hospital setting, it will not be possible to restore neurons destroyed during the progression of the disease. Also, treatment will not restore the affected neurodynamic functions of the brain. But the disadvantages of treatment do not end there. Therapy involves taking huge doses of vitamin B1. Against this background, it is quite possible for a severe allergic reaction to occur (up to anaphylactic shock, Quincke's edema and severe urticaria), for this reason you should not self-medicate.
Why is it important to treat amnestic syndrome?
Amnestic syndrome that appears against the background of alcoholism or for other reasons should not be left to chance. If the disease is not treated, memory lapses will appear more and more often, and the brain will begin to fill in the “gaps” with fantasies or false memories. As the disease progresses, the patient will increasingly believe his new memories. But in any case, memory restoration therapy must be carried out in parallel with the treatment of the illness that caused the amnesia. If the syndrome is the result of alcoholism, then first you will have to remove the patient from the binge state and only then begin to replenish vitamin B reserves and improve the functioning of the central nervous system.
Many people believe that memory loss caused by amnestic syndrome is the province of the elderly and people who have experienced serious traumatic brain injuries. But in fact, this disease is much more dangerous and insidious. We can say with complete confidence that every person who abuses alcohol is at risk. No one can predict when the disease will manifest itself for the first time and what consequences this may have. But one thing is certain: amnestic or Korsakoff syndrome in people suffering from alcoholism is almost always the result of vitamin B1 deficiency. Thiamine is very easily and quickly eliminated from the body under the influence of ethanol. Each serving of intoxicating drink removes part of the vitamin B reserves from the body’s “bins”. When there is nothing left to deduce, amnesia will begin.
Treatment
Treatment: in case of acute amentive syndrome caused by a somatic illness, detoxification therapy, combating dehydration and cardiovascular weakness (danger of collapse); Currently, psychotropic (neuroleptic) drugs are successfully used for their common indications. For endogenous diseases - treatment of the underlying disease.
Bibliography:
Korsakov S.S. Selected works, p. 175, M., 1954; Yudin T.I. Amentia and neurasthenia, in the book: Probl. acute exogenous psychic. diseases, ed. T. I. Yudin and M. A. Goldenberg, p. 78, Kharkov, 1935; Bleuler M., Willi J. u. Bühler HR Akute psychische Begleiterscheinungen körperlicher Krankheiten, Stuttgart, 1966; Bonhoeffer K. Die Psychosen im Gefolge von akuten Infektionen. Allgemeinerkrankungen und inne-ren Erkrankungen, Handb. Psychiat., hrsg. v. G. Aschaffenburg, Abt. 3, spec. T., Hlft. 1, S. 2, Lpz. - Wien, 1912; Meynert T. Klinische Vorlesungen über Psychiatric auf wissenschaftlichen Grundlagen, S. 33, Wien, 1890; Pauleikhoff V., Müller-Fahlbusch H. and Meissner U. Die Amentia, Fortschr. Neurol. Psychiat., S. 125, 1967.
E. Ya. Sternberg.
